Defense planners are now testing their new electronic medical records system at a second set of sites, confident that better training and better messaging will lead to fewer conflicts and concerns than they saw in the first wave of rollouts, officials told Federal Times this week.

The move comes about five months after the military’s transition to the MHS GENESIS records system was blasted by internal department watchdogs as “not operationally effective” and lacking “enough workable functionality” as the system was deployed to its first four medical sites.

But military officials and industry partners in the sweeping medical records overhaul insist that most of those concerned expected challenges in adapting military personnel to using a new system, not critical flaws in the multi-year plan to replace legacy records with the updated option.

“I definitely see a shift in adoption and in excitement,” said Stacy Cummings, head of the Program Executive Office for Defense Healthcare Management Systems, in an interview with Federal Times.

“Everybody I have talked to would say this is our future … from legacy to MHS GENESIS is a very positive comparison.”

The four new sites — California’s Naval Health Clinic Lemoore, Travis Air Force Base, Presidio of Monterey and Idaho’s Mountain Home Air Force Base — come after months of work at four other West Coast military medical installations. Deployment to those sites was pushed back by several months because of issues brought up at the previous sites.

According to Cummings, all of the problems that surfaced in that initial testing fell into three categories: users didn’t like the new system; users requested additional improvements; or users found errors in design.

Cummings said while trouble tickets and reports generally work to address the last two types of issues, fixing the first required better training and explanation for why the system was changing.

“Army, Navy, Air Force, Marines all have deeply embedded cultures, a great sense of pride about their culture, including the way they deliver care,” said Jerry Hogge, senior vice president of military and health solutions at Leidos Health, which is managing the records overhaul.

Planners are hopeful those changes will lead to fewer problems and complaints with the next wave facilities to start working with the new medical records.

“For the first [testing] sites we focused on kind of a button-ology approach, versus training against the workflows in the context of each role,” Hogge said.

“So that’s the most fundamental change: the pacing and the timing of the training, the intensity of the at-the-elbow support, the systems of trainers post go-live.”

The initial four sites will also see updates to their training to address some of the gaps that were identified during the earlier parts of their MHS GENESIS deployment. That includes developing advanced users at each of the sites that can help train their colleagues.

“We’re restructuring the way we’re delivering training to incorporate some of our lessons learned but also to incorporate some of the things we’ve heard about commercial best practice thinking.”

Officials said they’ve already seen patient care improvements at the initial test sites as a result of the new system. Outpatient visits were up 32 percent in the first half of the year as appointment efficiency improved. Hospital staffers estimated more than 2,300 duplicate lab orders were eliminated.

And, according to Hogge and Cummings, current MHS GENESIS operations meet about 85 percent of commercial best practices.

That number could go higher, but it also accounts for practices within the Department of Defense — such as identity management and pharmacy policies — that don’t match up with the private sector. There are also areas for which the private sector has no single best practice for GENESIS to align with.

Assuming the records system work proceeds without the problems seen earlier this year, Cummings said the next wave of deployments should come at the end of FY19. That pushes the full deployment of MHS GENESIS from 2022 to the end of 2023.

The Coast Guard announced in April 2018 that it would join the DoD’s GENESIS contractand, according to Cummings, Coast Guard officials are currently included in planning in the program office, but not yet ready to deploy at a particular site.

“What we’re doing now is trying to understand the uniqueness of the Coast Guard geographically, what does their network look like, what is the best way to deploy to the Coast Guard. And we’re working through those right now,” Cummings said.